经导管肝动脉栓塞在治疗外伤性肝破裂出血中的应用

Transcatheter arterial embolization in the treatment of traumatic hepatic hemorrhage

目的探讨经导管肝动脉栓塞(transcatheter arterial embolization,TAE)治疗外伤性肝破裂出血的临床价值。方法对22例经CT等检查确诊的闭合性肝外伤破裂出血患者,采用超选择插管至出血的肝脏血管,造影发现出血后用明胶海绵和(或)弹簧圈栓塞,观察止血效果及并发症。结果经导管造影发现肝实质出血20例,阳性率为90.9%,另2例造影阴性患者因检查发现仍有活动性出血行手术止血。20例造影阳性的患者行栓塞治疗,有17例患者止血成功,另有3例患者在栓塞后24~72 h后发现肝脏继续有出血行手术止血,总的栓塞成功率77.3%(17/22)。17例栓塞成功患者有3例在5~7天后出现肝周脓肿和胆漏,经穿刺置管引流后均顺利出院。结论对于大多数创伤相对较轻的肝破裂出血患者,TAE能有效控制肝脏活动性出血,创伤小,恢复快,值得临床应用。

Objective To evaluate the clinical effect of transcatheter arterial embolization( TAE) in the treatment of patients with traumatic hepatic hemorrh-age. Methods 22 patients with traumatic hepatic bleeding underwent transcatheter hepatic arterial angiography and followed by embolization with gelatin sponge and spring coil. Hemostatic effect and complications were observed. Results Among 22 cases,20 cases were found to have liver hemorrhage by hepatic arterial angiography,17 cases were then successful hemostasis after embolization,and 3 cases performed hemostatic operation because of continued bleeding within 24 ~ 72 hours after TAE therapy. The total success rate of hemostasis was 77. 3%( 17 /22). Liver abscess and bile leakage were found in 3 patients within 5 ~7 days after TAE therapy,but all of them discharged smoothly after percutaneous catheter drainage. Conclusion TAE is an effective and safe procedure in the treatment of traumatic hepatic hemorrhage.